Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA
| Autor: | Anna Kopczak, Andreas Schindler, Dominik Sepp, Anna Bayer-Karpinska, Rainer Malik, Mia L. Koch, Julia Zeller, Christoph Strecker, Daniel Janowitz, Frank A. Wollenweber, Johann-Martin Hempel, Tobias Boeckh-Behrens, Clemens C. Cyran, Andreas Helck, Andreas Harloff, Ulf Ziemann, Sven Poli, Holger Poppert, Tobias Saam, Martin Dichgans |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
diagnostic imaging [Plaque
Atherosclerotic] carotid plaque pathology [Carotid Arteries] stroke recurrence epidemiology [Carotid Stenosis] complications [Carotid Stenosis] etiology [Ischemic Attack Transient] Risk Factors ischemic stroke Humans Carotid Stenosis ddc:610 Ischemic Stroke etiology [Stroke] carotid artery intraplaque hemorrhage diagnosis [Stroke] Plaque Atherosclerotic complications [Plaque Atherosclerotic] Stroke Carotid Arteries Ischemic Attack Transient diagnostic imaging [Carotid Stenosis] epidemiology [Ischemic Attack Transient] Cardiology and Cardiovascular Medicine pathology [Plaque Atherosclerotic] epidemiology [Stroke] MRI |
| Zdroj: | Journal of the American College of Cardiology 79(22), 2189-2199 (2022). doi:10.1016/j.jacc.2022.03.376 |
| DOI: | 10.1016/j.jacc.2022.03.376 |
| Popis: | Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA).The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA.Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933). |
| Databáze: | OpenAIRE |
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